Sleep and Brain Injury

Studies have long shown that sleep deprivation, especially when chronic, can have detrimental effects to our health.

Just to name a few, poor sleep quality can impair brain activity, cognitive function, decision-making, concentration, learning, memory, balance, coordination, and emotional state. It also increases the chance of being involved in an accident.

All of these are common to the symptom profile of brain injury survivors. One of the most frustrating lingering effects from my concussion was disrupted sleep. At night, I had trouble falling asleep, staying asleep, and entering deep sleep. I either felt like I was half awake or I’d have terrible and vivid nightmares.

During the day, I was beyond tired and frequently took long, restless naps. I thought that I would never get better until a simple change to my sleep schedule triggered drastic improvements across all of my symptoms.

A neuropsychologist was the first to suggest that I focus my efforts solely on waking up at the same time each morning. Coupled with avoiding napping, this reset my circadian rhythm (i.e. internal clock) and improved the quality of my sleep. The medical director of the sleep laboratory that I visited also recommended this approach. After adhering to the new routine for just a few days, my headaches lessened in frequency and severity, the brain fog lifted, my mood stabilized, and I was able to tolerate more stimulation. Instead of relying on pharmaceuticals, I have adopted the following strategies for sleeping problems to my lifestyle.

Guidelines for Optimizing Sleep Health

Reset your Circadian Rhythm

Our bodies were meant to sleep after sun set and to wake with the sun rise. In fact, the highest quality of sleep that you can have is before midnight. However, bright lights in large cities, sedentary lifestyles, and modern technology has resulted in bad sleep habits that disrupt our internal biological clocks. Here are different ways that you can reset your circadian rhythm.

Go camping for one week

Studies have shown that camping for at least one week can reset adults’ internal clocks. This result was contributed to increased exposure to natural sunlight during the day and reduced exposure to artificial lights at night. That means that you don’t have to go camping to sync your body’s clock to nature’s light and dark cycle. See other strategies below.

Set your alarm and wake up at the same time, every single day

Setting a daily routine will help your body shift its circadian rhythm. It is difficult to control when you fall asleep at night, so focus more on when you wake up. Be sure to get out of bed as soon as the alarm goes off. If desired, set your wake up time half an hour earlier every three to four weeks, until you’ve reached the ideal time for your lifestyle. Eventually, your body will be conditioned to naturally wake up at the same time. The remaining tips will help you fall asleep faster and will make getting out of bed easier.

Get exposure to sunlight

Get at least half an hour of sunlight during the day. According to my sleep clinic, this is most effective if done within 30 minutes of waking up.

If you must take a nap in the middle of the day, set an alarm and don’t nap for more than 20 minutes.

Avoid blue light before bedtime

Artificial lights and electronic devices emit blue wavelengths of light that suppress the secretion of melatonin, a hormone that regulates sleep.3 Using a TV, computer, phone, or tablet within 1 hour before bed will make your brain think that it’s still day time and disrupt your circadian rhythm.

An extreme method

I stayed awake for 36 hours straight so that I would be sleepy enough to fall asleep at an appropriate hour on the second night. I then applied all of the other healthier techniques moving forward. My neuropsychologist said that this extreme method is not appropriate for everyone, so consult your doctor first.

Adjust your diet

Avoid caffeine after 10 am

An even better idea would be to give up caffeine altogether for at least four weeks. Keep in mind that caffeine may be hidden in foods and beverages other than coffee and tea. This includes chocolate (i.e. cocoa), soft drinks, energy waters or drinks, coffee or chocolate flavoured ice cream, medications, etc.

Avoid alcohol

Alcohol’s initial effects may make you feel sleepy, but it will actually wake you up in the middle of the night and/or decrease the quality of your sleep.

Don’t eat three hours before bedtime

You shouldn’t go to bed hungry either, so if you must eat before bed, choose healthy, light snacks and consume small portions.

Adjust your lifestyle

Regular physical activity, especially outdoors, will do wonders for your overall and sleep health. But if you exercise after 6 pm, it may end up stimulating instead of relaxing you.

You don’t want to condition yourself to associate your bed with any activities other than sleeping. Also, if you’re unable to fall asleep or fall back asleep after 30 minutes, get out of bed and do something that is non-stimulating and does not involve electronic devices. When you feel sleepy, go back to bed and try again.

Don’t try too hard

When it’s time for bed, don’t try too hard to fall asleep. If you focus on the fact that you aren’t able to sleep, count the hours left in the night, or fixate on all of the things that you need to do the next day, stress and anxiety will prevent you from relaxing and will keep you awake even longer.

Inspect your bedroom

Ensure that your mattress has the right firmness for your comfort.

Ensure that your pillow supports your neck sufficiently.

Use blackout curtains in your bedroom.

Remove all artificial lights and electronic devices from your bedroom.

This will also prevent you from looking at the clock when you’re having trouble sleeping in the middle of the night. Checking the time when you can’t sleep can stress you out and keep you awake.

Take a hot bath or shower

Taking a nice hot bath or shower will relax you, but doing so within 2 hours prior to bedtime will keep you awake.

Write down your stressors and plans

As our bodies relax, our minds tend to wander and fixate on past mistakes, present stressors, and future plans. So 2 to 3 hours before bedtime, sit down with a pen and paper and write down your concerns, ideas, and to-do lists. Then set them aside so that you don’t have to worry about them until the next day.

Turn off lights and electronic devices before bedtime

At least 1 hour prior to bedtime, turn off all electronic devices. It is also preferable to turn off all of the lights. At the very least, dim the lights or use candlelight. Research also shows that wearing amber lenses in the evening can be effective at blocking blue light and improving sleep quality.5 Furthermore, keep all lights and devices turned off if you wake up in the middle of the night and are unable to fall back asleep. Just be very careful making your way to and using the bathroom in the dark.

Have a warm beverage

Drink a cup of warm milk before bed, because it contains tryptophan, an amino acid that promotes sleep. Alternatively, a naturopath recommended drinking a cup of herbal tea (e.g. chamomile flowers, lemon balm, or tulsi/holy basil) within 30 minutes to one hour before bed. If you are taking any medications, speak to your doctor and/or pharmacist to ensure that your herbal teas won’t interact with your drugs.

Take a magnesium supplement

Taking magnesium 30 minutes to one hour prior to bed may help with sleep disturbances. Consult your doctor and/or pharmacist to determine your proper dosage and to ensure that it won’t interact with any of your medications.

Wash your face and brush your teeth 1 hour prior to going to bed

Washing my face and brushing my teeth, especially when done with the lights on, tends to invigorate me, so I do these before I really start to wind down.

Engage in a relaxing activity

The goal of your night routine is to unwind your mind and relax your body before bedtime. Try a non-stimulating activity such as meditation, gentle yoga or stretching, colouring, or reading a boring book or magazine.

I still struggle with fatigue and sleep some days, but I’m confident that if I consistently practice these good habits, high quality sleep will soon come easily.

Alison suffered a concussion in 2013 that completely changed her lifestyle. She is finding her way back to her old self and still loves traveling, dogs, cooking, and helping others. She hopes to help other brain injury survivors and their caregivers by sharing her experience and by spreading awareness.